More Patients Collect Prescriptions In Integrated Healthcare Systems

Healthcare systems that link pharmacy data with electronic health records see better compliance with patients picking up their medications, reports Kaiser Permanente study.
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If you are a diabetic, have high cholesterol, or high blood pressure and you receive medical care at an integrated healthcare system that has electronic health records (EHRs) linked to its own pharmacy, then you are more likely to collect your new prescriptions than people who receive care in a non-integrated system, a Kaiser Permanente study shows.

The study, Characteristics of Patients with Primary Non-adherence to Medications for Hypertension, Diabetes, and Lipid Disorders, examined pharmacy dispensing records of 12,061 men and women who were members of Kaiser Permanente Colorado in 2007 and 2008. It found that only 7% did not get their new prescriptions for blood pressure medication filled, 11% failed to pick up new prescriptions for diabetes medication, and 13% failed to collect new prescriptions for cholesterol-reducing medication. The study was published on the Journal of General Internal Medicine's website.

The researchers noted that previous studies of patients who are members of non-integrated health systems showed primary nonadherence (i.e., when prescriptions are not filled), to be as much as 22%, but said that the figure could represent an overestimation because "in a non-integrated system, medication orders from one organization must be linked with pharmacy claims from a different organization. Pharmacy claims databases do not include information on patients who never pick up their first prescription, nor do they contain information on patients who paid cash for their prescription," they said in a statement.

According to the researchers, the evidence suggests that integrating clinical information with pharmacy systems increases the level of accuracy in identifying patients with primary nonadherence. Additionally, the data can support clinical decisionmaking efforts that can improve patient outcomes, especially for those suffering from a chronic disease.

"Medication order entry within electronic health records has enhanced the potential to identify patients with primary nonadherence. Further, within integrated systems where EHR prescription order entry, pharmacy information systems, and dispensing pharmacies are routinely used, prescriptions ordered through the EHR can be more readily linked to dispensing data to ascertain whether a prescription order was ever sold to the patient," the report stated.

Dr. Marsha Raebel, the study's lead author, told InformationWeek Healthcare that technology can play a significant role in assisting pharmacy employees and patients to improve adherence to medications for diabetes, lipid problems, and high blood pressure, which is important in preventing harmful outcomes such as stroke.

Raebel, who is also an investigator in pharmacotherapy with the Kaiser Permanente Colorado Institute for Health Research and the University of Colorado School of Pharmacy, said linking EHR computerized physician order entry (CPOE) to pharmacy dispensing information helps clinicians and researchers identify patients that do not collect their new prescriptions and noted that every avenue needs to be explored that can uncover important evidence to improve medication adherence.

"Our results provide evidence that EHR and CPOE technology can assist us in identifying patients who likely need more assistance to optimize their medication adherence," Raebel said.

Based on their findings, researchers concluded that: "To directly address primary nonadherence, rather than using databases to attempt to predict patients likely to not initiate therapy, we recommend that healthcare systems pursue directly linking orders with dispensed prescriptions."

The report went on to say: "This linkage, supplemented with qualitative or mixed-methods research to enhance understanding of patient attitudes and beliefs amenable to intervention and quantitative clinical trials to determine optimal interventions, can result in reduced numbers of patients with primary nonadherence."

Find out how health IT leaders are dealing with the industry's pain points, from allowing unfettered patient data access to sharing electronic records. Also in the new, all-digital issue of InformationWeek Healthcare: There needs to be better e-communication between technologists and clinicians. Download the issue now. (Free registration required.)

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